3. Sideline Coverage Principles
• Introduce yourself to medical personnel
• Emergency Action Plan (EAP)
• Review location of AED and medical
equipment/resources
• Emergency Services – transportation
• Onsite vs Offsite
6. Objectives
• Determine the extent of the injury
• Describe initial assessment strategies
• Make a decision regarding return to play
7.
8. Case 1: Ocular injury
• 20 y.o. baseball athlete attempting to
bunt, ball deflected striking him in the
right eye
• Reports blurred
vision and swelling
9. Sideline Evaluation
• Assess visual acuity first
• Count fingers vs letters
• Examine structures of the eye
• Globe, sclera, lacrimal duct, pupil size/shape
• Extraocular movements
• Symmetry, nystagmus
• Palpate orbital rim
12. Traumatic Hyphema
• Blood in the anterior chamber
• Eye pain, photophobia, blurred vision
• ~37% of hyphema from sports injuries
• Avoid NSAIDs
• Common sports – racquet sports,
baseball, and softball
13. Hyphema Treatment
• Eye shield placed
over the affected eye
• Treat vomiting
• Keep supine and
head elevated to 30
degrees
• Transport to ER for
evaluation with
ophthalmology
14. Return to play - Hyphema
• Limit activity for one week after initial
injury
• Many ophthalmologists will limit reading
given concern for stress on blood vessels
• If hyphema remains present > 7 days
continue with activity limitation
15. Case 2: Dental Injury
• 21 y.o. field hockey athlete struck in the
face with a stick
• Comes to sideline
holding a tooth in
her hand
• No headache or
loss of
consciousness
16. Sideline Management - Tooth Avulsion
• Replantation within 5-10
minutes
• Rinse debris off root
• Hold pressure to limit
bleeding
• If unable to replant,
place tooth in milk or
other storage media
• Transport to dentist
17. Return to play – Avulsed tooth
• Athletes who undergo replantation with
splinting should wait at least 2-4 weeks
before return
• Mouth guard necessary
• Athletes who do not undergo replantation
could return within 48 hours, assuming no
bone fracture
• Mouth guard needed
18.
19. Case 3: Shoulder Injury
• 18 y.o. football athlete went to tackle an
opposing running back
• Felt a sharp, burning
pain radiating down
his right arm
• Tingling sensation
in fingers
20. On field/Sideline Management
• Palpate for any spinal tenderness
• Neurovascular examination upper
extremities
• Strength
• Sensation
• Pulses
• Range of motion
• Neck and upper extremities
23. Burner/Stinger
• Most common brachial plexus injury in
athletes
• Collegiate football athletes incidence 49-
65% in career
• Mechanism
1. Brachial plexus stretch/traction
2. Nerve root compression in neural foramina
3. Direct blow to brachial plexus
24. Burner/Stinger
• Lateral neck flexion
with contralateral
shoulder
• Exam external rotator
muscles, deltoid, and
biceps strength
• ROM neck and
shoulder
25. Return to play Yes if…
• Full painless range of motion neck/shoulder
• Resolution of parathesias
• Negative Spurling’s and brachial plexus
stretch
• Normal motor strength – neck/shoulder
26. Return to play No if…
• Midline neck pain or pain with neck ROM
• Shoulder Weakness
• Persistent parathesias
• Bilateral upper extremity symptoms
• Any lower extremity symptoms
27. Case 4: Head Injury
• 20 y.o. soccer goalie attempting to make
a save and kicked in the head
• Develops headache and nausea
• No LOC
• No history of head
injury
35. Return to play
• No athlete diagnosed with a concussion
should be returned to play in the same
day
• Undergo a return to play protocol before
restarting physical activity/sport
36.
37. Case 5: Heat Illness
• 16 y.o. F cross country athlete; after
completing a 10k complains of myalgias,
dizziness, and nausea. Temperature
outside was 92F degrees.
38. On-Field Management
• ABCs
• Vital Signs (rectal temperature)
• Obtain more history (coach, parent,
teammate)
• Medications,
• Past medical history
• Possible drug use
• Assess skin for perspiration
39. Heat Illness
Heat Cramps
• Involuntary, painful contractions of
skeletal muscle during or after
prolonged exercise.
• Typically resolves with cessation of
activity and stretching.
Heat Exhaustion
•Body temperature > 39⁰C but <
40⁰C with inability to continue
exercising.
•Should resolve with cessation of
activity and sweating.
Heat Stroke
•Rectal temp > 40-41⁰C (104-105 ⁰F)
with associated symptoms.
•Heat generated exceeds heat lost,
leading to rise in core temperature and
thermoregulatory failure.
40. Acute Heat Exhaustion Management
• Oral rehydration
• Remove excessive clothing
• Place in supine position with legs
elevated
• Monitor mental status
41. Acute Heat Stroke Management
• Cold water immersion
• “Cool First, Transport Second”
• “Golden half hour”
• Evaporation cooling techniques
• Cool mist while warm air is fanned over
• Cooling blanket and ice packs to
axilla/groin/neck
43. Return to play after heat exhaustion
• Resolution of symptoms
• Typically return to training within 24-48 hours
• Nutrition/hydration
• Sport specific issues – equipment
indoor/outdoor
• Environmental conditions
44. ACSM Return to play after heat stoke
1. Refrain from exercise for > 7 days
2. F/u in 1 wk for physical examination and
repeat labs or diagnostic imaging of
affected organs
3. When cleared, begin exercise in cool
environment; gradually increase
duration, intensity, and heat exposure for
2 wk to acclimatize and demonstrate
heat tolerance
45. ACSM Return to play after heat stoke
4. If return to activity is difficult, consider
laboratory exercise-heat tolerance test
about 1 month post-incident
5. Clear the athlete for full competition if
heat tolerance exists after 2 to 4 wk of
training
46.
47. Case 6: Ankle Injury
• HPI: 17 y.o. M point guard stepped on an
opponent’s foot. Left ankle inverted.
Developed lateral ankle pain with
associated swelling. Pain with weight
bearing. Denies popping or clicking.
48. Sideline Evaluation
• Assess for bony point tenderness
• Medial/lateral malleolus, base of fifth
metatarsal, navicular
• Assess for ligamentous laxity
• Ability to bear weight
• Neurovascular status
52. Return to play
• Timing of return depends on severity of
ankle sprain
• Functional testing
• Proprioception, ROM, strength, testing
balance, and agility
• Lateral hop test
• Restoration of sport specific skills
53. References
• Anthony Luke, Lyle Micheli. Sports Injuries: Emergency Assessment and Field-side Care Pediatrics in Review Sep 1999, 20 (9) 291-300; DOI: 10.1542/pir.20-9-291
• Davis GA, Purcell L, Schneider KJ, et al. The Child Sport Concussion Assessment Tool 5th Edition (Child SCAT5): Background and rationale. Br J Sports Med 2017;
51:859.
• Echemendia RJ, Meeuwisse W, McCrory P, et al. The Sport Concussion Assessment Tool 5th Edition (SCAT5): Background and rationale. Br J Sports Med 2017;
51:848.
• Glazer JL. Management of heatstroke and heat exhaustion. Am Fam Physician. 2005 Jun 1;71(11):2133-40. Review. PubMed PMID: 15952443.
• Gould, Trenton E et al. “National Athletic Trainers' Association Position Statement: Preventing and Managing Sport-Related Dental and Oral Injuries.” Journal of
athletic training vol. 51,10 (2016): 821-839. doi:10.4085/1062-6050-51.8.01
• Micieli JA, Easterbrook M. Eye and Orbital Injuries in Sports. Clin Sports Med. 2017 Apr;36(2):299-314. doi: 10.1016/j.csm.2016.11.006. Review. PubMed PMID:
28314419.
• Navarro CS, Casa DJ, Belval LN, Nye NS. Exertional Heat Stroke. Curr Sports Med Rep. 2017 Sep/Oct;16(5):304-305. doi:
10.1249/JSR.0000000000000403. Review. PubMed PMID: 28902747.
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